Provider Demographics
NPI:1023035003
Name:NATHAN H. BRANDON, MD, LLC
Entity Type:Organization
Organization Name:NATHAN H. BRANDON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-396-7671
Mailing Address - Street 1:4409 EVANS TO LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3603
Mailing Address - Country:US
Mailing Address - Phone:706-396-7671
Mailing Address - Fax:706-396-7676
Practice Address - Street 1:4409 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-396-7671
Practice Address - Fax:706-396-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA72BBBBLMedicare ID - Type UnspecifiedNATHAN H. BRANDON, MD
GAG05377Medicare UPIN